public health Archives - Professor Tony Magaña

Christian approach to willfully unvaccinated. Leave them to their fate!

Jesus Christ with his Apostles at the Last Supper

Rather than fighting about personal rights vs public health there is a Christian answer Jesus gives to his followers obviating this prominent protracted conflict about COVID-19 vaccination. Leave the willfully unvaccinated to their fate.

Although a little more than 50% of the adult population has voluntarily chosen to be vaccinated in most of the United States in contrast many Southern and Midwestern states have communities with rates as low at 10%. There is essentially universal concurrence among medical experts that vaccination will spare millions from death, prolonged illness, and disability with a very low risk of side effects.

Conservative political activists and politicians have redirected the discussion to one that focuses on the dangers of government mandates while ignoring the Constitutionally tested provision to promote the general welfare power of the government to mandate public health measures that are reasonable to protect the population. At this point I believe continued repetitive attempts to “enlighten” the immunization resistors will fail. The Center for Disease control had wanted to reach a 70% percent level of immunization to get to herd immunity which could reduce the epidemic to a rare occurrence.

Jesus in his ministry wanted his followers to make a conscious decision to follow him. Human beings are created by God with free will to sin or to love. To make right or wrong decisions for their own benefit. Being coerced into religion could not lead one to be truly faithful. Taking away that free will reduces one’s ability to willfully act justly. In the Gospel of Matthew he says if you are shunned by those who do not want you to visit or listen to you then you have no obligation to continue your effort to convince them. Instead you should “shake the dust of your feet” and move on. This is consistent with Christian morality.

I think this is the way we should deal with the anti-vaccination groups and individuals. If they become ill or die they will bear the burden of their actions. Those that believe in vaccination have the absolute right not to associate with them.

Floridians reluctance to COVID-19 immunization

“You can bring a horse to water but you can’t make him drink!”

A reflection on Florida’s #COVID-19 Crisis and reluctance to vaccination

So yesterday I am in my local Walmart store in Florida which has become the new town square of suburban America. Every five minutes the speaker system throughout the large superstore is announcing that free COVID 19 vaccines are available with minimal waits right now. It was about 6 PM on a sunny afternoon and the store was moderately filled with a heterogeneous group of shoppers of different ethnic groups and ages. I wondered how many of them knew that Florida had become the number one state of new infections over the past week.

I remembered that the Republican party in Florida had said that yes COVID 19 was dangerous but only to seniors and that young people should not worry. Florida Governor DeSantis just a few months ago said the virus was no worse then the flu and that it would not cause significant hospitalizations. Now of course the rising tide of affliction is affecting, hospitalizing, and killing greater numbers of people ages 20 to 40 because the delta variant making up 83% of cases is much more infectious. In Florida this group has had low vaccination rates.

As I walked through the Walmart nobody was wearing a mask. The hand sanitizing station was unattended. Everyone entering the store just passed by it. Then I wondered over to the pharmacy to see if there was a line to get immunized. To my surprise there was none.

This made me think about an an old saying I learned a long time ago when I was working on ranch in South Texas. “You can bring a horse to water but you can not make him drink!” If we look at vaccination as an analogy to water we can see that the constant barrage by conservatives and other anti-vaxers has created a malignant lie that the water is poisoned. Large numbers of people have been convinced that they should act against not only their own interest but against that of their family, their community, their nation, and even the world. Let us hope that the horse will get thirsty enough to finally take that drink. For this to happen they have to realize that they have become pawns in a political power struggle that cares about winning not about health.

Interpersonal Violence and Head Injury in Tigray:Public Health Issue

The head injury problem especially that due to interpersonal violence in Tigray is a growing and significant problem which requires a public health approach.

3d CT scan of man suffering depressed fracture of skull from stone injury

Research published by Fasika et al showed that 24.8% of head injury admissions came from interpersonal violence from 2011 to 2014 which was before neurosurgery was permanently established at Ayder Comprehensive Specialized Hospital. Currently we are seeing about 10 patients a day and operating on 2 to 3 every day. Most of the surgeries we do are for depressed fractures caused by stone injury received in interpersonal violence. The age range of these injuries ranges from preschool to the eighth decade of life. We know there is a cultural proclivity to this type of injury but it is not well studied.

The hospital burden of head injury includes about 19% of adult ICU admissions and bedspace and 25% of pediatric ICU admissions and bed space. Our average daily census on the adult ward is 5 for head injury and on the pediatric ward also 5. The length of stay can vary from 24 hours to months with most of the surgical patients requiring a least a 5 days stay in the hospital.This burden acts to limit the care those suffering from other maladies can receive.

At the current time there is no public health or government plan to try to prevent these injuries.The World Health Organization has created a Violence Prevention Alliance which sees interpersonal violence as requiring a public health approach.

This public health approach to violence prevention seeks to improve the health and safety of all individuals by addressing underlying risk factors that increase the likelihood that an individual will become a victim or a perpetrator of violence.

The approach consists of four steps:

1 To define the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences of violence.
2 To establish why violence occurs using research to determine the causes and correlates of violence, the factors that increase or decrease the risk for violence, and the factors that could be modified through interventions.
3 To find out what works to prevent violence by designing, implementing and evaluating interventions.
4 To implement effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and the target outcome should be monitored, and their impact and cost-effectiveness should be evaluated.

By definition, public health aims to provide the maximum benefit for the largest number of people. Programs for the primary prevention of violence based on the public health approach are designed to expose a broad segment of a population to prevention measures and to reduce and prevent violence at a population-level.

I propose that Mekelle University put together a multidisciplinary team consisting of not only physicians but also social scientists, public health professionals, police and prosecutors ( this was previously discussed with the head of the Tigray police who was interested), and government stakeholders. This type of investigation and policy development is exactly the type of activity which the University with all its resources and knowledge base should be tackling.